ENVH Refund ETHarnett
COUNTY
NORTH CAROLINA
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number:
110-0000-345.18-00
Project Number:
Vendor Name:
Lyon Builders, Inc.
Vendor Number:
Remittance Address:
P 0 Box 569
Date 8-31-11
Olivia, NC 27368
Mail to payee
F]Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Description
Amount
Environmental Health Existing Tank Fee
$ 100.00
Application # # 11-5-27414
Site: Carolina Seasons S/D Lt 26-H
Total Amount Due
$ 100.00
Reason for check request: System destroyed during house fire and subsequent demolition of house. Repair
permit issued on 8-10-11 #26682 by Oliver Tolksdorf. No existing tank needed.
Environmental Health owes a refund of $100.00 for the existing tank inspection.
This check request has been examined by me and is hereby approved for payment.
Department H r t o ized ignee <
Date
Graham H. Byrd, R.E.H.S
This instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director